Sportswell Limited Mail or FAX Order Page
| Simply Print and Mail or FAX Payment To: | |
| Sportswell Limited | |
| 47 Rutherford Drive, | |
| Waikanae 6010 | |
| NEW ZEALAND | |
| Phone: 0064 4 293 2597 | |
| Payment payable to "Sportswell Limited" | |
| Contact Information | |
| First Name: | _________________________________________________ |
| Last Name: | _________________________________________________ |
| Phone Number: | _________________________________________________ |
| Fax Number: | _________________________________________________ |
| Email: | _________________________________________________ |
| Delivery Address | _________________________________________________ |
| _________________________________________________ | |
| _________________________________________________ | |
| _________________________________________________ | |
| Payment Details | If you are paying by Credit Card, please fill in the required information below. |
| Name as on Credit Card | _________________________________________________ |
| CC# Street Address | _________________________________________________ |
| CC# City | _________________________________________________ |
| CC# Country | _________________________________________________ |
| CC# State | _________________________________________________ |
| CC# Zip/Country Code | _________________________________________________ |
Quantities
| Description | Price $US | Number | Total Price |
| 1 bottle " Velvita" plus postage | 33.95 | ||
| 2 bottles "Velvita" plus posatge | 63.95 | ||
| 4 bottles "Velvita" - 1 free plus postage | 105.95 | ||
| 1 spray bottle "Velvita" IGF-1 | 43.95 | ||
| Total Price in US$ (add $9.95 for postage) | 9.95 |
Add air postage of $9.95 to all orders
Multiply US$ by NZ$ Exchange Rate to convert to NZ $ if sending a personal check, bank check or money order.
Shipping
Shipping by New Zealand Post Air International - 4 to 12 days delivery.
Credit Card Details
Please circle the credit card type: VISA, MASTERCARD
Credit Card Number:_____________________________
Credit Card Expiration Date:_______________________
Signature of CC holder:___________________________
Date:_________________________________________